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General NPI Number Information
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NPI Number | 1013356245
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Entity Type | Organization
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Legal Business Name | SULPHUR UROLOGY LLC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 1327 STELLY LN SUITE 2
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City | SULPHUR
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State | LA
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Zip | 70663-5641
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Country | US
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Telephone | 337-528-7898
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 STELLY LN SUITE 2
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City | SULPHUR
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State | LA
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Zip | 70663-5641
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Country | US
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Telephone | 337-528-7898
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Fax | 337-528-7427
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. THOMAS ALDERSON
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Credential | MD
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Telephone | 337-528-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD07139R
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License Number State | LA
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